Upshaw's1 excellent review of hemodynamic changes after cardioversion for atrial fibrillation reports and analyzes the occurrence of acute pulmonary edema after cardioversion of atrial fibrillation. However, pulmonary edema can also complicate reversal of atrial flutter as the following case illustrates.
A 57-year-old black man with a history of hypertension, congestive heart failure, mitral regurgitation, and atrial flutter for the past 2 weeks was admitted for progressive shortness of breath, dyspnea on exertion, and palpitations for the past 3 days. He was found to have congestive heart failure and atrial flutter with variable atrioventricular block and rapid ventricular response. At the time, he was being treated with digitalis, angiotensin-converting enzyme inhibitors, diuretics, β-adrenergic blocking agents, calcium-channel blocking agents, and anticoagulation therapy.
Castro VJ. Acute Pulmonary Edema After Overdrive for Atrial Flutter. Arch Intern Med. 1998;158(6):679. doi: